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Meet the Editors

 and joined the MJH Life Sciences team in December 2019. She graduated from Youngstown State University in 2019 with a bachelor's degree in journalism and a minor in political science. Prior to graduating, Morgan worked as the editor-in-chief of her college newspaper. She went on to work as an assignment editor at a broadcast news station in Youngstown, Ohio before joining 

 You can reach her at mpetronelli@mjhlifesciences.com.

Articles

AAP issues new report urging early, routine screening for mental, emotional, and behavioral problems in pediatric care to improve outcomes.

AAP updates guidance on screening for mental, emotional, and behavioral problems in children

A cross-sectional study finds large proportions of obesity-related conditions in US youth are attributable to obesity and, to a lesser extent, overweight.

Obesity contributes substantially to chronic conditions in US adolescents and young adults

Colleen Sloan, PA-C, RDN is a board-certified PA and registered dietitian. 

Pediatricians play a crucial role in preventing early-onset colorectal cancer by promoting healthy diets and fiber intake among children.

Addressing early-onset colorectal cancer in pediatric practice: Prevention starts now

FDA approves updated COVID-19 vaccines for 2025-2026 but limits pediatric access, restricting use to older and high-risk groups.

FDA pulls clearance of Pfizer-BioNTech COVID-19 vaccine for children under 5

Contemporary Pediatrics connects pediatricians with peer-reviewed articles, guideline updates, and practice strategies for real-world clinical application.

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The pandemic underscored the incredible power of vaccination.

Considering a society free of vaccine-preventable diseases

**Editor's Note** Please note that starting January 1, 2025, we will be switching to an online-exclusive publication process. This will allow us to publish case submissions quicker without having to deal with the variables that come along with print publication. All cases will still be eligible for print publication consideration, but publication in our print magazine is not guaranteed and will be up to the editor's discretion. 

Do you have a puzzling pediatric case that you’d like to share with the readers of 

We are looking for intriguing diagnoses that have stumped the experts—a diagnostic “Puzzler”—to help our physicians enhance their day-to-day practices. If you have such a story to tell, tell us.

Here’s what to do: Before you begin, we suggest that first you review the Puzzler 

https://www.contemporarypediatrics.com/case-studies

. Please note the specific style required for writing Puzzler manuscripts.

Next, prepare a draft of your case, including a summary of the presenting symptoms, a case overview, a 

table of the differential diagnosis (MANDATORY)

, and the special aspects of your case that qualify it as a Puzzler, and send it to us. Please note that the differential diagnosis table should also be discussed in the body text. We’ll review your draft and let you know what you need to add or revise before we send the manuscript to peer review for evaluation.

Puzzlers vary in length, and we suggest a minimum of 1,200 words up to a maximum of 2,000 words, but that is because of the complexity of some cases and whether some patients returned for many assessments before their diagnoses were determined. Also, some authors describe the pathophysiology of the differentials in great detail. Please also note no more than 3 authors are allowed per article.

What's most important is to show us the process that you used to analyze the case, including:

Why you decided to order certain tests and why you did not order others.

Peer consultations or why you elected to contact other specialists.

Lab values including vital signs or blood tests.

Labs and values if your patient was attended to in the emergency department or other hospital departments such as radiology or neurology.

Discussion related to the possible diagnoses.

Final diagnosis, treatment, prognosis, and follow-up.

Remember to indicate numbered citations within the body of the text and include a complete list of corresponding literature/references at the end of the manuscript. (Do not use any citation management programs or unlink them.) 

Limit references to 25. No references (unless it is a seminal study) can be older than 10 years.

We prefer primary research as references, but some cases are so obscure that authors will need to pull from a variety of sources. However, 

. Be advised that peer reviewers are adamant that the disease/disorder you describe was actually diagnosed and not determined by index of suspicion on the basis of ruling out various differentials. We use AMA11 as our publication style, which uses superscript citation numbers and a corresponding numbered reference list. Please create your citations and references in this style.  Check this recent article posted online at 

https://www.contemporarypediatrics.com/view/the-rx-of-adhd

 for examples of reference style. IMPORTANT NOTE WITH AMA 11TH EDITION: PLEASE PUT DOI OR WEBSITES/URLS AT THE END OF THE REFERENCE LINE.

When you send your draft manuscript, also 

. These image files must be high-resolution jpg or tiff files (minimum of 300 dpi) and as large in size as possible. We suggest a minimum of 7 horizontal inches. The images must be original photos with clear permissions to use, not images from copyrighted sources. Send as separate attachments with your e-mail submission; do not embed images into your manuscript document.

After we receive your manuscript, our editors and peer reviewers will review your draft and let you know if we accept your submission for publication. 

Puzzler is one of the departments for which we receive the most submissions, so it may be several months after submission before you receive feedback from us.

If we do accept your submission for publication, we will contact you with further instructions.

Send your submissions in Microsoft Word format to 

, via e-mail to mpetronelli@mjhlifesciences.com

Guidelines for PUZZLER, Contemporary Pediatrics

On August 27, the FDA authorized updated formulations of COVID-19 vaccines for the 2025-2026 season, but significantly tightened restrictions on their use in younger populations.

The changes coincide with the Department of Health and Human Services’ (HHS) decision to withdraw Emergency Use Authorizations for several vaccines, including Pfizer-BioNTech’s Comirnaty, Moderna’s Spikevax, and Novavax’s protein-based option. The move eliminates the broad pediatric access that had previously been in place.

Pfizer announced that the new Comirnaty formulation received approval for adults 65 and older and for individuals aged 5 to 64 with underlying health conditions. However, it is no longer authorized for children under 5 years of age, marking a major shift from earlier allowances.

The FDA has gradually reduced vaccine access under Secretary Robert F. Kennedy Jr’s leadership, narrowing indications to higher-risk groups and older adults. Novavax’s Nuvaxovid was cleared in May for individuals aged 12 and older with medical risk factors, and Moderna’s Spikevax received approval in July for children between 6 months and 11 years old who face increased susceptibility to severe illness.

These decisions collectively mark a transition from widespread pediatric use of COVID-19 vaccines to a more targeted approach centered on older adults and those with underlying vulnerabilities.

Susan J. Kressly, MD, FAAP, president of the American Academy of Pediatrics (AAP), stated, "Today’s announcement from US Department of Health and Human Services Secretary Robert F. Kennedy, Jr, proposing to limit the availability of COVID-19 vaccines for children and young adults is deeply troubling. The American Academy of Pediatrics remains focused on increasing access to vaccines for all children, in all communities. As we enter respiratory virus season, any barrier to COVID-19 vaccination creates a dangerous vulnerability for children and their families. Respiratory illnesses can be especially risky for infants and toddlers, whose airways and lungs are small and still developing."

According to Kressly, the AAP advises that all children from 6 months to 23 months receive the COVID-19 vaccine. For children 2 years and older, annual vaccination is recommended for those with underlying conditions that heighten the risk of severe illness.

Both Kressly and the AAP emphasized that families should continue to have the option to vaccinate their children, noting that the recent HHS decision removes this choice for many and creates additional uncertainty for parents seeking to safeguard their children’s health. Additionally, she stressed that vaccination decisions are best made jointly by parents and pediatricians and urged federal officials to preserve this role for medical professionals and families.

Eaton ES. FDA approves updated COVID-19 jabs, with strict limitations for young people. FirstWord Pharma. August 27, 2025. Accessed August 27, 2025. https://firstwordpharma.com/story/5992579

Pfizer and BioNTech’s COMIRNATY receives US FDA approval for adults 65 and older and individuals ages 5 through 64 at increased risk for severe COVID-19. News release. Pfizer Inc-BioNTech SE. August 27, 2025. Accessed August 27, 2025. https://www.businesswire.com/news/home/20250822994391/en/Pfizer-and-BioNTechs-COMIRNATY-Receives-U.S.-FDA-Approval-for-Adults-65-and-Older-and-Individuals-Ages-5-through-64-at-Increased-Risk-for-Severe-COVID-19

AAP says decision to limit children’s access to vaccines is deeply troubling. News release. AAP. August 27, 2025. Accessed August 27, 2025. https://www.aap.org/en/news-room/news-releases/aap/2025/aap-says-decision-to-limit-childrens-access-to-vaccines-is-deeply-troubling/

News

 poll. Take a look at the following case below. After reading through the description, choose a multiple-choice answer and try to guess the correct patient diagnosis.

Then visit our website on August 20 at 12:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

This case was provided by Andrew Faniku, MD, pediatric hospitalist at Scott & White Healthcare.

A 21-year-old primigravida female presented to the hospital in preterm labor, with an otherwise uneventful pregnancy except for a febrile illness after exposure to family members with measles a week prior.

She reported having fever, cough, conjunctivitis, and a rash that started on her face and spread to her trunk, consistent with measles. Her fever and symptoms had mostly resolved, except for her lingering rash that began six days earlier. In the delivery room, she still had fresh excoriation marks on her arms. She had not received any MMR vaccines.

Six hours after admission, the patient delivered a female infant via spontaneous vaginal delivery at 35 weeks’ gestation. The baby weighed 2410 grams, which was approximately the 50

 percentile for her gestational age. The baby had mild respiratory distress after delivery and briefly required supplemental oxygen via blow by during transitioning. Apgar’s of 8 at 1 minute and 9 at 5 minutes was given at delivery. The baby subsequently improved and was allowed to room in with mother without the need for NICU admission. Nursing staff noticed a rash on the baby’s back. 

Below, take your best guess at diagnosing this patient

 website on Wednesday, August 20 at 12:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

Case Studies

Can you diagnose this rash in a newborn?

Bite injuries are a significant problem in the United States. Discriminating between human and animal bites and identifying those associated with child maltreatment is essential. Approximately 250,000 human bites and several million animal bites occur annually.

 There was also a reported increase in animal bite injuries during the COVID-19 pandemic.

 Despite their frequency, it can be challenging to distinguish between types of bites. There are also few detailed images and descriptions of cutaneous findings of human and animal bites in the literature. 

Additionally, though such injuries occur in various ways, pediatric providers must consider the possibility of child maltreatment. In the COVID-19 pandemic, there was also a documented increase in child abuse–related injuries.

 Though bite wounds are a less common cutaneous finding in child abuse,

 both human and animal bites may result from nonaccidental trauma or neglect. 

In the poll below, try to identify what caused this bite mark on the palm of a 16-year-old boy

Thank you for taking this Contemporary Pediatrics puzzler poll

Visit ContemporaryPediatrics.com on Wednesday, August 6, 2025, at 12:00 PM ET or later for many more bite examples in the pediatric population and how to distinguish between common animal bites and human bites.

"This [case] was prompted by the increases in child abuse and animal bite injuries during the COVID-19 pandemic, with the need to add to the limited descriptions of cutaneous findings of bites in the literature," wrote the authors of this case.

Bula-Rudas FJ, Olcott JL. Human and animal bites. 

. 2018;39(10):490-500. doi:10.1542/pir.2017-0212

Dixon CA, Mistry RD. Dog bites in children surge during coronavirus disease-2019: a case for enhanced prevention. 

. 2020;225:231-232. doi:10.1016/j.jpeds.2020.06.071

Kovler ML, Ziegfeld S, Ryan LM, et al. Increased proportion of physical child abuse injuries at a level I pediatric trauma center during the Covid-19 pandemic. 

. 2021;116(Pt 2):104756. doi:10.1016/j.chiabu.2020.104756

Kos L, Shwayder T. Cutaneous manifestations of child abuse. 

. 2006;23(4):311-320. doi:10.1111/j.1525-1470.2006.00266.x

Despite their frequency, it can be challenging to distinguish between types of bites. Can you identify the source of this bite mark? 

Puzzler poll: Can you identify this bite? 

A diet high in omega-3 polyunsaturated fatty acids (PUFAs), primarily obtained from fish oils, may lower the risk of myopia in children, according to findings published in the 

. In contrast, a diet rich in saturated fats, such as those found in butter, palm oil, and red meat, may increase the risk of the condition.

The global prevalence of myopia continues to rise, with projections suggesting that nearly half of the world’s population will be affected by 2050. Risk factors for myopia are understood to include excessive near work, limited time outdoors, and genetic predisposition. Diet, however, has been less well established as a modifiable factor influencing refractive development.

Researchers from the Hong Kong Children Eye Study analyzed dietary patterns and ocular health outcomes in 1005 Chinese children aged 6 to 8 years. The cross-sectional study used a validated food frequency questionnaire covering 280 food items across 10 food categories. Axial length (AL) and cycloplegic spherical equivalent (SE) refraction were measured to assess eye growth and refractive status.

Among the participants, 276 children (27.5%) were found to have myopia. Analysis demonstrated that axial length was significantly longer in children in the lowest quartile of omega-3 fatty acid intake compared with those in the highest quartile (adjusted mean, 23.29 mm vs 23.08 mm; 

 = .01). SE also showed a protective association, with the lowest quartile group averaging more myopic refractions (−0.13 D) compared with the highest quartile (+0.23 D; 

 = .01). Conversely, children in the highest quartile of saturated fat intake demonstrated longer AL and more myopic SE compared with those in the lowest quartile.

“This study provides the human evidence that higher dietary ω-3 PUFA intake is associated with shorter axial length and less myopic refraction, highlighting ω-3 PUFAs as a potential protective dietary factor against myopia development,” the investigators concluded.

The biological mechanisms underlying these associations may relate to ocular blood flow. Omega-3 fatty acids are believed to increase choroidal blood circulation, supplying oxygen and nutrients to the sclera and thereby reducing scleral hypoxia, a known factor in myopia development. In contrast, saturated fats are associated with insulin resistance, which has been hypothesized to play a role in excessive axial elongation.

The study builds on prior animal research that has suggested a protective role for omega-3 fatty acids in slowing myopia progression. For example, supplementation in animal models has been shown to suppress experimentally induced myopia and reduce scleral hypoxia. However, this is the first large-scale study in humans to establish a significant association between dietary omega-3 intake and myopia.

While the findings highlight a potential dietary strategy for mitigating myopia risk, the authors acknowledged important limitations. As an observational cross-sectional study, the data cannot establish causality. The use of food frequency questionnaires introduces the possibility of recall bias, and dietary intakes were not validated with serum biomarkers. Additionally, the study population was limited to Chinese children in Hong Kong, a population with one of the world’s highest myopia prevalence rates, which may limit generalizability to other ethnic groups and geographic regions.

Higher omega-3 intake may protect children from myopia, while diets high in saturated fats may raise risk, study finds.

Judy Stewart

Articles

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